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American College of
Emergency Physicians
National Association
of EMS Physicians
American Academy
of Pediatrics
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Principles of
Prehospital Care
The goal of prehospital care is
to minimize further systemic
insult or injury and manage lifethreatening conditions through
a series of well defined and
appropriate interventions, and to
embrace principles that ensure
patient safety. High-quality,
consistent emergency care demands
continuous quality improvement
and is directly dependent on the
effective monitoring, integration,
and evaluation of all components
of the patients care.
Integral to this process is medical
oversight of prehospital care by
using preexisting protocols (indirect
medical oversight), which are
evidence-based when possible, or
by medical control via voice and/or
video communication (direct medical
oversight). The protocols that guide
patient care should be established
collaboratively by medical directors
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Required Equipment:
Basic Life Support
(BLS) Ambulances
A. Ventilation and Airway Equipment
1. Portable and fixed suction
apparatus with a regulator
(per Federal specifications;
see Federal Specification
KKK-A-1822F reference)
Wide-bore tubing, rigid
pharyngeal curved suction
tip; tonsillar and flexible
suction catheters, 6F16F are
commercially available (have
one between 6F and 10F and
one between 12F and 16F)
2. Portable oxygen apparatus,
capable of metered flow
with adequate tubing
3. Portable and fixed oxygen
supply equipment
Variable flow regulator
4. Oxygen administration
equipment
Adequate length tubing;
transparent mask (adult
and child sizes), both
non-rebreathing and
valveless; nasal cannulas
(adult, child)
5. Bag-valve mask (manual
resuscitator)
Hand-operated, selfreexpanding bag; adult
(>1000 ml) and child (450
750 ml) sizes, with oxygen
reservoir/accumulator;
valve (clear, disposable,
operable in cold weather);
and mask (adult, child,
infant, and neonate sizes)
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6. Airways
Nasopharyngeal (16F34F;
adult and child sizes)
Oropharyngeal (sizes 05;
adult, child, and infant sizes)
7. Pulse oximeter with
pediatric and adult probes
8. Saline drops and bulb
suction for infants
B. Monitoring and Defibrillation
All ambulances should be
equipped with an automated
external defibrillator (AED)
unless staffed by advanced life
support personnel who are
carrying a monitor/defibrillator.
The AED should have pediatric
capabilities, including childsized pads and cables.
C. Immobilization Devices
1. Cervical collars
Rigid for children ages
2 years or older; child
and adult sizes (small,
medium, large, and
other available sizes)
2. Head immobilization
device (not sandbags)
Firm padding or
commercial device
3. Lower extremity (femur)
traction devices
Lower extremity, limbsupport slings, padded
ankle hitch, padded pelvic
support, traction strap
(adult and child sizes)
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6. Adhesive tape
Various sizes (including 1
and 2) hypoallergenic
Various sizes (including
1 and 2) adhesive
7. Arterial tourniquet
(commercial preferred)
E. Communication
Two-way communication
device between EMS provider,
dispatcher, and medical control
F. Obstetrical Kit (commercially
packaged is available)
1. Kit (separate sterile kit)
Towels, 4x4 dressing,
umbilical tape, sterile
scissors or other cutting
utensil, bulb suction,
clamps for cord, sterile
gloves, blanket
2. Thermal absorbent blanket
and head cover, aluminum
foil roll, or appropriate
heat-reflective material
(enough to cover newborn)
G. Miscellaneous
1. Sphygmomanometer
(pediatric and adult
regular and large
size cuffs)
2. Adult stethoscope
3. Length/weight-based tape or
appropriate reference material
for pediatric equipment sizing
and drug dosing based on
estimated or known weight
4. Thermometer with low
temperature capability
5. Heavy bandage or paramedic
scissors for cutting clothing,
belts, and boots
6. Cold packs
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9. Disposable trash
bags for disposing of
biohazardous waste
10. Respiratory protection
(for example, N95 or N100
maskper applicable
local or state guidance)
Required Equipment:
Advanced Life Support
(ALS) Ambulances
2. Protective helmet
3. Fire extinguisher
4. Hazardous material
reference guide
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B. Vascular Access
1. Crystalloid solutions, such
as Ringers lactate or normal
saline solution (1,000-mL
bags x 4); fluid must be in
bags, not bottles; type of fluid
may vary depending on state
and local requirements
2. Antiseptic solution (alcohol
wipes and povidoneiodine wipes preferred)
3. IV pole or roof hook
4. Intravenous catheters 14G24G
5. Intraosseous needles or
devices appropriate for
children and adults
6. Venous tourniquet,
rubber bands
7. Syringes of various sizes,
including tuberculin
8. Needles, various sizes (one at
least 1 for IM injections)
9. Intravenous administration
sets (microdrip and
macrodrip)
10. Intravenous arm boards,
adult and pediatric
C. Cardiac
1. Portable, battery-operated
monitor/defibrillator
With tape write-out/
recorder, defibrillator
pads, quick-look paddles
or electrode, or handsfree patches, ECG leads,
adult and pediatric chest
attachment electrodes, adult
and pediatric paddles
2. Transcutaneous cardiac
pacemaker, including
pediatric pads and cables
Either stand-alone
unit or integrated into
monitor/defibrillator
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Analgesics, narcotic
and nonnarcotic
Antiepileptic medications, such
as diazepam or midazolam
Sodium bicarbonate, magnesium
sulfate, glucagon, naloxone
hydrochloride, calcium chloride
Bacteriostatic water and
sodium chloride for injection
Additional medications as
per local medical director
A. Optional Equipment
1. Glucometer (per
state protocol)
2. Elastic bandages
Nonsterile (various sizes)
3. Cellular phone
4. Infant oxygen mask
5. Infant self-inflating
resuscitation bag
6. Airways
Nasopharyngeal (12, 14 Fr)
Oropharyngeal (size 00)
Cardiopulmonary/respiratory
medications, such as albuterol
(or other inhaled beta agonist)
and ipratropium bromide,
1:1,000 epinephrine, furosemide
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7. 3.55.5 mm cuffed
endotracheal tubes
8. Needle cricothyrotomy
capability and/or
cricothyrotomy capability
(surgical cricothyrotomy
can be performed in older
children in whom the
cricothyroid membrane
is easily palpable, usually
by the age of 12 years)
Optional Medications
A. Optional Basic Life
Support Medications
1. Albuterol
2. Epi pens
3. Oral glucose
4. Nitroglycerin (sublingual
tablet or paste)
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Pulling Tools/Devices
Appendix
Air bags
Extrication Equipment
Adequate extrication equipment
must be readily available to the
emergency medical services
responders, but is more often found
on heavy rescue vehicles than on the
primary responding ambulance.
In general, the devices or tools
used for extrication fall into several
broad categories: disassembly,
spreading, cutting, pulling,
protective, and patient-related.
Ropes/chains
Come-along
Hydraulic truck jack
Protective Devices
Reflectors/flares
Hard hats
Safety goggles
Fireproof blanket
Leather gloves
Jackets/coats/boots
Patient-Related Devices
Stokes basket
Miscellaneous
Shovel
1. Anxiolytics
Disassembly Tools
Wrenches (adjustable)
Floodlights
Interfacility Transport
Pliers
Tin snips
Bolt cutter
Hammer
Spring-loaded center punch
Axes (pry, fire)
Bars (wrecking, crow)
Ram (4 ton)
Spreading Tools
Hydraulic jack/spreader/
cutter combination
Cutting Tools
Saws (hacksaw, fire, windshield,
pruning, reciprocating)
Air-cutting gun kit
Lubricating oil
Wood/wedges
Generator
Local extrication needs may
necessitate additional equipment for
water, aerial, or mountain rescue.
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Selected References
American Academy of Pediatrics Section
on Transport Medicine. Guidelines for
Air and Ground Transport of Neonatal and
Pediatric Patients, 3rd edition. George A.
Woodward, MD, MBA, FAAP (ed). 2007.
American College of Surgeons Committee
on Trauma, Advanced Trauma Life Support
Student Course Manual (8th Edition). 2008.
American Heart Association,
Pediatric Advanced Life Support
Provider Manual. 2006.
Brennan JA, Krohmer J (eds), Principles
of EMS Systems. Sudbury, MA: Jones
and Bartlett Publishers, 2005.
Brown MA, Daya MR, Worley JA.
Experience with chitosan dressings
in a civilian EMS system. J Emerg
Med. 2007:Nov 14 (doi:10.1016/j.
jemermed.2007.05.043).
Cervical spine immobilization
before admission to the hospital.
Neurosurgery. 2002;50(3 Suppl):S717.
Doyle GS, Taillac PP. Tourniquets: a
review of current use with proposals
for expanded prehospital use. Prehosp
Emerg Care. 2008;12(2):241256.
Equipment for Ambulances
ACEP Policy Statement, American College
of Emergency Physicians and Medical
Direction of Emergency Medical Services.
Available at: http://www.acep.org.
Federal Specifications for the Star-of-Life
Ambulance KKK-A-1822F. August 1, 2007.
Future of EMS in the US
Health Care System
Institute of Medicine, May 17, 2007
Available at: www.iom.edu.
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